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Open or closed pinning for distal humerus fractures in children?
A S de Buys Roessingh1, O Reinberg
1Department of Paediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne. Anthony.debuys-roessingh@chuv.hospvd.ch
Insights
Percutaneous pinning (PP) is effective for pediatric distal humerus fractures, including supracondylar (SC) and internal humeral condylar (IHC) types. Experienced surgeons can minimize risks associated with PP, making it a viable surgical option.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Traumatology
Background:
- The optimal surgical approach for pediatric distal humerus fractures, specifically percutaneous pinning (PP) versus open pinning fixation (OPF), remains debated.
- Particular controversy surrounds the use of PP for internal humeral condylar (IHC) fractures in children.
Purpose of the Study:
- To compare the efficacy and outcomes of percutaneous pinning (PP) and open pinning fixation (OPF) for treating various distal humerus fractures in pediatric patients.
- To evaluate the complication rates and functional recovery associated with each surgical method.
Main Methods:
- A retrospective review of 80 pediatric distal humerus fractures treated surgically over ten years.
- Fracture types included supracondylar (SC), comminuted (COM), internal humeral condylar (IHC), and lateral humeral condylar (LHC).
- Surgical interventions comprised PP, OPF, and screw osteosynthesis.
Main Results:
- PP significantly reduced hospitalization duration for SC and IHC fractures compared to OPF.
- PP demonstrated lower rates of extension deficiency and cubitus valgus in SC fractures, and cubitus varus in IHC fractures.
- PP was associated with a higher incidence of cubitus valgus in IHC fractures and some neurological complications (radial and ulnar nerve involvement).
Conclusions:
- Percutaneous pinning (PP) is a suitable surgical technique for both supracondylar (SC) and internal humeral condylar (IHC) fractures in children.
- Careful execution by experienced surgeons is crucial to mitigate the risk of neurological damage when using PP.
Introduction:
In children, the choice between percutaneous pinning (PP) and open pinning fixation (OPF) for the surgical treatment of fractures of the distal humerus remains controversial, especially the PP method for internal humeral condylar (IHC) fractures.
Patients And Methods:
Eighty fractures of the distal humerus in children were treated surgically in our hospital over a ten year period. 47% (n = 38) were supracondylar (SC), 20% (n = 16) comminuted (COM), 18% (n = 14) internal humeral condylar (IHC), and 15% (n = 12) lateral humeral condylar (LHC). We used PP, OPF and three times osteosynthesis with screws.
Results:
In comparison to OPF, PP reduced the length of hospitalization in SC fractures (2.8 versus 6.1 days) and IHC fractures (2.4 versus five days). It reduced the risk of extension deficiency (11.1% versus 15%) and of cubitus valgus (0% versus 20%) in SC fractures, and of cubitus varus in IHC fractures (0% versus 11.1%). However it induced a higher rate of cubitus valgus (11.1% versus 20%) in IHC fractures, one persistent neurological motor deficiency (radial nerve) and four cases of transitional neurological involvement (ulnar nerve).
Conclusions:
PP is a good surgical method for SC and for also for IHC fractures, if performed by experienced surgeons so as to avoid neurological damage.